An inflammation or irritation around the tailbone or coccyx is called coccydynia. Pain and tenderness is present around the coccyx and may include the buttocks and sacrum. Most patients complain of pain when sitting.
The condition may be caused by an inflammation of the soft tissues generally referred to as bursitis or by a trauma caused by a fall, but, in most causes the condition has no specific identifiable cause.
The initial assessment for coccydynia may include x-rays to rule other causes, and occasionally an MRI if significant bursitis is suspected.
Treatment may include oral medications such as NSAIDS. A program of stretching of the back, pelvic, and hamstring muscles is warranted and occasionally this is administered with the assistance of a physical therapist. A local injection with a steroid agent can be effective in many cases. Occasionally, an epidural steroid injection is recommended. Most patients need to be coached in a behavioral program that slowly introduces sitting for longer and longer periods of times. Sometimes patients with recalcitrant pain will use seat cushions, but this is general only when other attempts to return to normal sitting activities fail.
In rare instances, surgery to remove or shorten the coccyx is recommended.